Signing Off On Fraud

A Bettendorf physician who worked for years in emergency medicine in the Quad-Cities has pleaded guilty to 24 counts of health care fraud in U.S. District Court.

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Before signing your name, it’s really important to know exactly what you are agreeing to. An Iowa physician signed off on more than 1,000 prescriptions that caused Tricare, the healthcare program for America’s military members, to be billed for more than $4.4 million in a healthcare fraud scheme that lasted only about two months.

The Bettendorf, Iowa doctor, who practiced emergency medicine for more than 20 years, got into trouble for “knowingly and willingly” signing off on drug prescriptions based on information that had been recorded by workers at foreign call centers. (The problem was that he approved the prescriptions without actually talking to the patient, conducting an exam or reviewing their medical records. So the question is, were they really medically necessary?)

The signed prescription forms were faxed to multiple pharmacies in Florida and California, where they were filled, then mailed to patients. (The physician signed off on 1,375 prescriptions for compounded medicines over a two-month period for 432 patients.) Tricare reimbursed the participating pharmacies for $4,436,190.  

Where this case differs from others is that as soon as the issue was brought to the doctor’s attention, he immediately reported himself to the Iowa Board of Medicine, as well as to other state boards where he was licensed to practice medicine. Further research reveals that he admitted he should have verified that the patients he signed off on had been seen by qualified healthcare providers first. (Here’s a great example of why you need to understand what you’re signing off on before writing your name on something that could have legal ramifications.)

The 45-year-old Iowa physician pleaded guilty to a total of 24 counts of healthcare fraud. He is facing a maximum of five years in prison for making false statements plus three years of unsupervised release, a $250,000 fine and a special assessment of $100 per count.

The physician must also pay $10,000 in restitution to Tricare. (His lawyer defended his client by explaining that during the very brief two-month period, the doctor had made a terrible mistake for which he received less than $11,000 from Tricare. It’s a good thing he realized his mistake and fessed up.) All of the State Medical Boards where he was licensed to practice agreed to allow the doctor to continue practicing medicine. He is scheduled to be sentence in January.

Perhaps this doctor has learned an important lesson regarding practicing medicine. To be a good doctor, it’s important to talk to your patient, examine them in person if possible and review their medical record to understand history. It’s also important to understand what your responsibilities are when participating as a provider for a government healthcare program; otherwise you could risk losing your livelihood for signing off on fraud.

Today’s “Fraud of the Day” is based on an article entitled, Bettendorf doctor pleads guilty to fraudpublished by The Quad-City Times on August 24, 2017.

A Bettendorf physician who worked for years in emergency medicine in the Quad-Cities has pleaded guilty to 24 counts of health care fraud in U.S. District Court for the Southern District of Iowa, Davenport.

Dr. Paul Matthew Bolger, 45, Bettendorf, pleaded guilty to 18 counts of false statements in health care matters, five counts of introduction of misbranded drugs and one count of making a false statement in health care matters in California, which was transferred to Iowa.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.